Chairs
Dr Chrissie Jones, St George's, University of London, UK
Dr Chrissie Jones, St George's, University of London, UK
Dr Chrissie Jones is an Associate Professor in Paediatric Infectious Diseases at the University of Southampton. Her research interests include interventions in pregnancy to prevent infection in early life. She has particular expertise in the field of maternal vaccination and leads pertussis and RSV clinical trials in pregnancy. She serves on the executive committee of GAIA (http://gaia-consortium.net), a large international consortium. As part of this initiative, Dr Jones has authored international guidelines to provide a standard for data collection in clinical trials of vaccines in pregnancy, which are recommended by the WHO.
Dr Jones is the chief investigator of RACE-FIT, a NIHR-funded feasibility study to assess an educational intervention to reduce the risk of CMV acquisition in pregnancy.
With postgraduate training in medical education, Dr Jones is involved with multiple initiatives to train and equip others in paediatric infectious diseases.
09:05-09:25
5.7 million neonatal deaths and stillbirths: infections, organisms and measurement black holes
Professor Joy Lawn FMedSci, London School of Hygiene & Tropical Medicine, UK
Abstract
Of the annual 2.7 million neonatal deaths, the most recent estimates for 196 countries suggest that neonatal infections causes approximately 600,000 deaths, almost double the number of child deaths from malaria plus HIV/AIDS. Yet for neonatal infections (apart from tetanus) there is much slower mortality reduction, and very limited global health investment. If the closely linked burden of 2.6 million stillbirths could be accurately assessed for infection, and the impairment outcomes for survivors of neonatal infection were included then the associated burden would be even more striking.
There are measurement black holes which impede evidence based investment and faster reduction of this burden, but could be targeted. For example, new analysis shows the important contribution of group B streptococcus to stillbirths, as well as neonatal invasive disease, with implications for cost-effectiveness of maternal vaccination. Some of the most important measurement black holes regarding neonatal infections will be detailed, highlighting opportunities for change, notably the following: aetiological data, stillbirth investigations including infection aetiology, impairment outcomes for survivors of neonatal infections, and measuring the coverage and quality of care.
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Professor Joy Lawn FMedSci, London School of Hygiene & Tropical Medicine, UK
Professor Joy Lawn FMedSci, London School of Hygiene & Tropical Medicine, UK
Joy is an African-born, British-trained paediatrician and perinatal epidemiologist with 25 years of experience including clinical care, epidemiological burden estimates, and the design and evaluation of integrated maternal, newborn and child care services at scale, especially in sub-Saharan Africa. Her medical degree and paediatric training were in the UK, followed by teaching, programme and research work, mainly in Africa, including a decade with Saving Newborn Lives/Save the Children. Her MPH was at Emory, Atlanta, USA, whilst working at CDC, and her PhD was through Institute of Child Health London.
Joy’s particular contribution has been in developing the evidence-base for policy and programming change to measure and address the global burden of 2.7 million neonatal deaths, 2.7 million third trimester stillbirths, and 15 million preterm births. This work came to prominence through Lancet Neonatal Survival series (2005), Lancet Stillbirth series in 2011 and 2016, and especially the Lancet Every Newborn series (2014) with the associated Every Newborn Action Plan, endorsed at the World Health Assembly and supported by >80 partners. She co-chairs the UN’s Every Newborn metrics work to increase the quantity, quality and use of data. She has published <150 peer reviewed papers, with an H index of over 80, as well as several widely used policy relevant reports, launched with major media attention, and a number of academic chapters.
She is currently professor of Epidemiology, at the London School of Hygiene & Tropical Medicine and Director of Maternal, Adolescent, Reproductive & Child Health (MARCH) centre including 200 academics from multiple disciplines organised around three research themes: Adolescents, Births, and Child health and development. She leads a research team of more than 20 scientists working on newborn health, stillbirths and child development around the world. She is the School’s Aurora Women’s Leadership Champion. Joy has been awarded a number of prestigious prizes such as the Nils Rosen von Rosenstein medal for paediatrics, PGPR Global Child Health award, Wolfson Royal Society Merit award and Fellowship of Academy of Medical Sciences.
09:40-10:00
Gram-negative bacterial infections in the neonate – global epidemiology
Dr Julia Bielicki, St George's, University of London, UK
Abstract
Gram-negative bacterial infections, in particular sepsis caused by Gram-negative bacteria, can have devastating consequences during the neonatal period. Rising levels of antimicrobial resistance among Gram-negative bacteria globally are an additional cause for concern, as therapeutic options are limited. In particular, data from lower and middle income countries, where neonates experience a high burden of infections with considerable associated mortality and morbidity, demonstrate that many Gram negative isolates are resistant to both first- and second-line empiric regimens recommended by the World Health Organization. Furthermore, there are a number of reports of outbreaks caused by multidrug resistant Gram-negative bacteria in the setting of neonatal inpatient care. It has been estimated that up to 30% of neonatal deaths due to sepsis are attributable to multi-drug resistant bacteria, with extended-spectrum beta-lactamase producing Gram negative bacteria being among the main culprits. However, available surveillance data is of insufficient quality to gain robust insights into the global epidemiology of neonatal Gram-negative bacterial infections. Improved and integrated surveillance is necessary to identify the areas of greatest therapeutic need in this population. Currently available antibiotic treatment options are limited, and the potential effectiveness of other interventions has not been sufficiently studied. Alternative interventions range from non-invasive attempts to influence the colonising microflora (for example through increased mother-baby skin-to-skin contact) to the prophylactic use of monoclonal antibodies against key bacteria.
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Dr Julia Bielicki, St George's, University of London, UK
Dr Julia Bielicki, St George's, University of London, UK
Julia Anna Bielicki is a Senior Researcher in Paediatric Infectious Disease at St George’s University of London. Julia trained in paediatrics and infectious diseases at the Evelina Children’s Hospital and St Mary’s Hospital, London, as well as in Zurich and Basel, Switzerland and in 2011 obtained a Master of Public Health degree from the London School of Hygiene and Tropical Medicine. Julia’s particular research interests are in observational and interventional studies that aim to improve antibiotic use for neonates and children in the light of an increasing burden of antimicrobial resistance and the need to conserve antibiotics for future generations. From 2011 to 2014, Julia co-ordinated the Antibiotic Resistance and Prescribing in European Children (ARPEC) Project, which recruited nearly 20’000 children from over 40 countries worldwide. Building on this, she will be leading a multi-national prospective observational cohort of neonatal sepsis and bloodstream infection as part of a new programme of work focusing on the impact of antimicrobial resistance on management of neonatal infection in lower and middle income countries.
10:50-11:10
Group B Streptococcal disease and neonatal susceptibility to infection
Professor Philipp Henneke, Center for Pediatrics and Center for Chronic Immunodeficiency, University of Freiburg, Germany
Abstract
Neonatal group B streptococcal sepsis is a highly inflammatory disease, where bacterial effectors induce cytokines leading to end organ failure, long term sequels and lethality. We have identified the interaction of streptococcal RNA and lipopeptides with Toll-like receptors and cytosolic sensors as key molecular events in this process. Moreover, tissue specific changes in immune cell composition under influence of the emerging microbiota substantially contribute to susceptibility to infection and course of the disease. Accordingly, manipulation of the site specific innate immune cell response on the cognate receptor level is a rational strategy for improving outcome in group B streptococcal sepsis.
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Professor Philipp Henneke, Center for Pediatrics and Center for Chronic Immunodeficiency, University of Freiburg, Germany
Professor Philipp Henneke, Center for Pediatrics and Center for Chronic Immunodeficiency, University of Freiburg, Germany
Philipp Henneke is Professor of Infection and Immunity and Head of the Division of Paediatric Infectious Diseases and Rheumatology at the Centre for Paediatrics and Adolescent Medicine (Medical Centre, University of Freiburg). He is Principal Investigator of a research and diagnostic laboratory, which focuses on antimicrobial phagocyte biology and innate immunity.
After graduating from Freie Universität Berlin, he received basic training in paediatrics and infectious diseases at the Children’s Hospital, Freie Universität Berlin. Subsequently, he worked as a Lecturer at Harvard Medical School, Boston and as an Assistant Professor at the University of Massachusetts Medical School. In 2003, he joined the Faculty of Medicine, Freiburg, as an Assistant Professor in Paediatric Infectious Diseases. Since then he has been appointed Full Professor.
Philipp Henneke has received several scientific awards, such as the ‘Young Investigator Award’ of the European Society for Paediatric Infectious Diseases, the ‘Hugo-Schottmüller-Award’ by the German Sepsis Society and the ‘Science Award’ by the German Society for Paediatric Infectious Diseases (DGPI).
Currently he is editor of the Journal of Pediatric Infectious Diseases, Board Member of the German society for paediatric infectious disease (DGPI) and Head of the Research Committee of the ESPID (European Society of Paediatric Infectious Diseases).
Philipp Henneke’s scientific area of interest is the development of foetal/neonatal innate immunity, molecular mechanisms in receptor mediated innate immunity to Gram-positive bacteria, immunodeficiency to bacterial infections, and novel translational approaches to adjuvant sepsis therapy. His clinical specialities are bacterial sepsis, and mycobacterial infections and congenital infections.
11:30-11:50
Global burden of congenital CMV infection
Professor Suresh Boppana, University of Alabama School of Medicine, USA
Abstract
Cytomegalovirus (CMV) is a leading cause of congenital infection worldwide. In the developed world, it is a leading non-genetic cause of childhood hearing loss and neurodevelopmental disabilities. The prevalence of congenital CMV infection is directly related to CMV seroprevalence in women of child-bearing age. Therefore, the populations in the developing world experience the higher prevalence of congenital CMV infection (1-5% of births) and are most likely driven by non-primary maternal infections. Although reliable estimates of prevalence and outcome from different regions of the world are not available, recent data demonstrating similar rates of hearing loss following primary and non-primary maternal infection have underscored the importance of congenital CMV infection in resource-poor settings. Therefore, successful implementation of strategies to prevent or reduce the burden of congenital CMV infection will require heightened global awareness among clinicians and the general population and a better understanding of the factors associated with intrauterine transmission of CMV following non-primary maternal infections. This talk will highlight the global epidemiology of congenital CMV with particular emphasis on the disease burden in resource-poor settings.
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Professor Suresh Boppana, University of Alabama School of Medicine, USA
Professor Suresh Boppana, University of Alabama School of Medicine, USA
Dr Suresh Boppana is a Professor of Pediatrics and Microbiology at the University of Alabama at Birmingham and directed the UAB Pediatric Infectious Diseases Training Program for 10 years. He has been studying the natural history and pathogenesis of maternal and congenital cytomegalovirus (CMV) infection. His research interests include the mechanisms of intrauterine transmission of CMV, global burden and pathogenesis of congenital CMV infection, and the consequences of CMV reinfections. His work challenged the dogma that most of the disease burden from congenital CMV infection is seen in children born to women with primary CMV infection during pregnancy and documented the impact of congenital CMV resource-limited settings with high seroprevalence. He showed that CMV reinfections occur frequently and can lead to intrauterine infection, symptomatic disease and sequelae. As the PI of a large multicentre study newborn CMV screening study supported by NIH, his group defined the contribution of congenital CMV infection to childhood deafness and developed a real-time PCR assay that has been shown to be highly sensitive and specific to detect CMV in newborn saliva specimens and can be adapted for newborn CMV screening. He mentored numerous trainees and served as a member NIH review committees. Dr Boppana is a Fellow of the American Academy of Pediatrics and Infectious Diseases Society of America, and an active member of the Pediatric Infectious Diseases Society and the American Society for Microbiology.
12:10-12:35
Neonatal innate immunity to RSV: from pathogenesis to protection
Dr Mirjam Belderbos, University Medical Center Groningen, The Netherlands
Abstract
Respiratory syncytial virus (RSV) is the leading cause of infant lower respiratory tract infection, accounting for 33.8 million episodes of acute respiratory tract infection and 66,000 – 199,000 deaths annually. Over 80% of severe RSV infections occur in otherwise healthy neonates and infants <6 months, urging for novel strategies to protect this vulnerable age group.
Toll-like receptor (TLR) responses play an essential role in the defence against RSV. Efficient viral clearance requires pathogen recognition through TLR4 and induction of a Th1-type immune response. In contrast, severe RSV disease is characterised by a Th2-type immune response, characterised by low levels of pro-inflammatory cytokines and high levels of IL-10. The distinct function of the neonatal TLR system, which is intrinsically biased against production of pro-inflammatory responses and favours production of IL-10, may predispose to severe RSV infection. This is supported by recent studies, which show that age-dependent differences in dendritic cells shape the immune response to RSV, and that neonatal dendritic cells require more co-stimulation than adult dendritic cells to induce protective responses.
The early postnatal period is essential for the development of the neonatal TLR system, and may provide a unique window of opportunity to prevent subsequent RSV bronchiolitis. For instance, environmental factors, such as breast feeding, presence of siblings and mode of delivery, have been shown to modulate postnatal TLR maturation. In addition, mechanistic studies have identified neonatal blood plasma as an important source of immune modulatory factors, which may provide novel targets to modulate neonatal innate responses and to optimise antiviral immunity.
This talk will discuss how insights into the neonatal innate immune system can be exploited to reduce the global burden of RSV infection.
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Dr Mirjam Belderbos, University Medical Center Groningen, The Netherlands
Dr Mirjam Belderbos, University Medical Center Groningen, The Netherlands
Dr Mirjam Belderbos is a paediatrician and clinician scientist. Her main interests include how immune impairments contribute to disease, such as infections, asthma and cancer, and how the immune system can be exploited to prevent and/or treat disease. This applies to known immune deficiency syndromes, but also to situations of ‘physiological’ immune tolerance, such as pregnancy and neonates.
Dr Belderbos obtained a PhD in immunology in 2011 (Professor Bont and Professor Meyaard, UMC Utrecht). Her thesis focuses on the neonatal innate immune system in the pathogenesis of Respiratory Syncytial Virus (RSV) bronchiolitis. Dr Belderbos’ work demonstrates that the first month of life is essential for the development of the innate immune system, during which neonatal Toll-like receptor responses shift from tolerant (Th2-polarised) responses to a more pro-inflammatory (Th1-polarised) phenotype. In collaboration with the group of Professor Ofer Levy, Harvard Medical School, she demonstrated that soluble mediators in neonatal plasma contribute to impaired neonatal innate immunity.
After finishing her PhD studies, Dr Belderbos moved to Groningen, where she combined her clinical training in paediatrics with a postdoctoral fellowship in Stem Cell Biology at the European Research Institute for the Biology of Ageing. Her work was awarded various personal and career grants. She is a reviewer for several journals in paediatrics, immunology and oncology. She is a member of the Dutch Cancer Society, the International Society of Experimental Hematology and the Dutch Society for Pediatrics.